Diabetes, older age, obesity and high blood pressure increase the risk of hospitalisation and death from COVID-19

The behaviour of previous coronaviruses together with physiological characteristics of diabetes may help explain why people with diabetes have a higher risk of developing COVID-19, a respiratory disease caused by the novel coronavirus SARS-CoV-2, according to a paper, ‘COVID-19 Pandemic, Corona Viruses, and Diabetes Mellitus’, published in the American Journal of Physiology-Endocrinology and Metabolism.

Approximately 10% of the population in the US has diabetes and more than a quarter of people in the US aged 65 or more have diabetes. Diabetes, older age, obesity and high blood pressure increase the risk of hospitalisation and death from COVID-19. Diabetes was also a risk factor for two respiratory illnesses caused by similar coronaviruses: severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) in 2012.

Previous research in human and animal models of diabetes suggests physiological traits exist that may explain why people with the disorder may be more likely to contract or develop a more serious case of COVID-19. Potential factors include:

increased expression of angiotensin-converting enzyme 2 in the lungs, heart, kidneys and pancreas, which SARS-CoV-2 binds to in order to enter human cells;

elevated levels of furin, a protein that, through its normal function, may make it easier for viruses to enter the body; and

impaired adaptive immunity, which includes sub-optimal functioning of white blood cells that fight infection and an exaggerated inflammatory response by the body towards COVID-19.

The authors emphasize the importance of identifying factors that can predict the severity of COVID-19 in people with diabetes and developing solutions to remotely monitor the health of this population.

"As the global pandemic unfolds and rapidly spreads across the US, social isolation measures will enable the transition [to provide remote patient monitoring], but there is an urgent need for basic and clinical investigations to address the many important and unanswered questions," they stated.